Provider Demographics
NPI:1891557898
Name:GRIMES, REGGIE D SR
Entity Type:Individual
Prefix:
First Name:REGGIE
Middle Name:D
Last Name:GRIMES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BONNACLIFF CT
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1001
Mailing Address - Country:US
Mailing Address - Phone:615-519-7425
Mailing Address - Fax:
Practice Address - Street 1:LAKESHORE HEARTLAND
Practice Address - Street 2:3025 FERNBROOK LN
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214
Practice Address - Country:US
Practice Address - Phone:615-316-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN517224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant